Towards establishing MS prevalence in Latin America and the Caribbean.

A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.

Incidence and prevalence of amyotrophic lateral sclerosis in Uruguay: a population-based study.

OBJECTIVE: To determine the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in the Republic of Uruguay. METHODS: The study was performed in Uruguay (3,241,003 inhabitants) during a 2-year period (2002-2003). To ensure complete case ascertainment, multiple sources of information were used, including all the neurologists, other medical specialties, general physicians, neurophysiology laboratories, hospital medical records and death certificates. ALS diagnosis was based on El Escorial criteria. Although all patients with motor neuron disease were enrolled in the follow-up, only probable and definite cases are included in the study. RESULTS: Between January 1st, 2002, and December 31st, 2003, 89 new patients were diagnosed with probable or definite ALS. The mean annual incidence rate was 1.37 per 100,000 persons. The incidence was higher for men (1.95) than for women (0.84) with a male to female ratio of 2:1. For both, the incidence increased throughout the years showing a peak in the 65-74 age group among men and the 55-64 age group among women. Mean age at onset of ALS disease was 58.7 years. The estimated mean annual incidence for ALS calculated by the capture recapture method was 1.42 (95% CI, 1.13-1.72). On December 31st, 2002, the crude prevalence was 1.9 per 100,000 inhabitants. CONCLUSIONS: ALS incidence is within a narrow range across countries despite the genetic, environmental and socioeconomic differences when similar prospective design, diagnosis criteria and data analyses are applied.

[The evolution of cerebrovascular accidents in the town of Rivera, Uruguay]. / Evolución del accidente cerebrovascular en la ciudad de Rivera, Uruguay.

INTRODUCTION: Improving the health care dispensed to patients who have suffered a cerebrovascular accident (CVA) requires a thorough knowledge of its evolution. AIMS: To examine the evolution of CVA and its subgroups by looking at the rates of mortality, recurrences and extra-neurological complications. We also sought to determine the value of different clinical scales and urinary incontinence at the beginning of CVA as factors that could potentially predict its severity. A third objective was to find out the time elapsed between the onset of CVA and the patient's contacting the medical team. PATIENTS AND METHODS: The study, which spanned the period between 1st March 2000 and 28th February 2002, was conducted in the town of Rivera, which has a population of 62 859 and is located in the north of the Eastern Republic of Uruguay. During the first year of the study, 79 patients with CVA were registered, each of whom was clinically monitored for a year. RESULTS: The mortality rate at one month was 24% and at one year rose to 38%. The validity of certain factors predicting mortality due to CVA was confirmed as a lower score on the Glasgow scale, a higher score on the NIH impairment scale, and the presence of urinary incontinence, haemorrhagic CVA and total anterior circulation syndrome. In 87.3% of cases the patient was attended within the first 24 hours. CONCLUSIONS: The findings of this study will make it possible to adopt health care strategies to improve the quality of medical attention, lower the mortality rate and prevent sequelae in CVA patients.

Evolución del accidente cerebrovascular en la ciudad de Rivera, Uruguay / The evolution of cerebrovascular accidents in the town of Rivera, Uruguay

Introducción. Mejorar la asistencia de los pacientes con accidente cerebrovascular (ACV) requiere un amplio conocimiento de su evolución. Objetivos. Estudiar la evolución del ACV y de sus grupos clínicos a través de la mortalidad, de las recurrencias y de complicaciones extraneurológicas. Determinar el valor de distintas escalas clínicas e incontinencia urinaria al inicio del ACV como eventuales factores pronósticos de su gravedad. Conocer el tiempo transcurrido entre la instalación del ACV y el contacto con el equipo médico. Pacientes y métodos. El estudio, que se extendió desde el 1 de marzo de 2000 al 28 de febrero de 2002, se realizó en la ciudad de Rivera, que tiene una población de 62.859 habitantes y está situada al norte de la República Oriental del Uruguay. Se registraron 79 pacientes con ACV durante el primer año del estudio; a cada uno de ellos se lo controló clínicamente durante un año. Resultados. La mortalidad al mes fue de 24% y al año de 38%. Se confirmó la validez de determinados factores pronósticos en la mortalidad por ACV como una menor puntuación de la escala de Glasgow, mayor puntuación de la escala de déficit del NIH, presencia de incontinencia urinaria, ACV hemorrágico y síndrome total de la circulación anterior. El 87,3% de los pacientes fue asistido en las primeras 24 horas. Conclusión. A partir del presente estudio, es posible adecuar estrategias sanitarias para mejorar la calidad de la asistencia médica, disminuir la mortalidad y prevenir secuelas en los pacientes con ACV

Introduction. Improving the health care dispensed to patients who have suffered a cerebrovascular accident (CVA) requires a thorough knowledge of its evolution. Aims. To examine the evolution of CVA and its subgroups by looking at the rates of mortality, recurrences and extra-neurological complications. We also sought to determine the value of different clinical scales and urinary incontinence at the beginning of CVA as factors that could potentially predict its severity. A third objective was to find out the time elapsed between the onset of CVA and the patient’s contacting the medical team. Patients and methods. The study, which spanned the period between 1st March 2000 and 28th February 2002, was conducted in the town of Rivera, which has a population of 62 859 and is located in the north of the Eastern Republic of Uruguay. During the first year of the study, 79 patients with CVA were registered, each of whom was clinically monitored for a year. Results. The mortality rate at one month was 24% and at one year rose to 38%. The validity of certain factors predicting mortality due to CVA was confirmed as a lower score on the Glasgow scale, a higher score on the NIH impairment scale, and the presence of urinary incontinence, haemorrhagic CVA and total anterior circulation syndrome. In 87.3% of cases the patient was attended within the first 24 hours. Conclusions. The findings of this study will make it possible to adopt health care strategies to improve the quality of medical attention, lower the mortality rate and prevent sequelae in CVA patients

[The incidence of cerebrovascular accidents in the town of Rivera, Uruguay]. / Incidencia del accidente cerebrovascular en la ciudad de Rivera, Uruguay.

INTRODUCTION: Knowledge about the epidemiology of cerebrovascular accidents (CVA), or stroke, in the town of Rivera, Uruguay, would be useful as the basis on which to apply health care strategies both in the prevention of risk factors and in early diagnosis and treatment. AIMS: To determine the incidence of CVA in the town of Rivera and to study the association between certain risk factors and the pathological type of CVA. PATIENTS AND METHODS: The study, which spanned the period between 1st March 2000 and 28th February 2001, was conducted in the town of Rivera, which has a population of 62,859 and is located in the north of the Eastern Republic of Uruguay. The sample consisted of 114 patients with CVA, of whom 79 had no previous history of CVA -first CVA in lifetime (FCVAL)-. RESULTS AND CONCLUSIONS: The incidence of CVA was 181.3 cases per 100,000 inhabitants per year. The incidence of FCVAL was 125.7 cases per 100,000 inhabitants per year. 73.4% of the FCVAL were ischaemic and 26.6% were haemorrhagic. A high percentage of arterial hypertension was found in patients with CVA (84%) and with FCVAL (80.7%), and a statistically significant association was observed between congestive heart failure and ischaemic CVA.

Incidencia del accidente cerebrovascular en la ciudad de Rivera, Uruguay / The incidence of cerebrovascular accidents in the town of Rivera, Uruguay

Introducción. El conocimiento de la epidemiología delaccidente cerebrovascular (ACV) o ictus en la ciudad de Rivera,Uruguay, puede servir de base para la aplicación de estrategiassanitarias tanto en la prevención de factores de riesgo como en eldiagnóstico y tratamiento precoces. Objetivos. Determinar la tasa deincidencia de ACV en la ciudad de Rivera y estudiar la asociaciónentre determinados factores de riesgo y el tipo patológico de ACV.Pacientes y métodos. El estudio, que se extendió desde el 1 de marzode 2000 al 28 de febrero de 2001, se realizó en la ciudad de Rivera,que tiene una población de 62.859 habitantes y está situada al norte de la República Oriental del Uruguay. Se incluyeron 114pacientes con ACV, de los cuales, 79 no tenían antecedentes de ACV–primer ACV en la vida (PACVV)–. Resultados y conclusiones. Latasa de incidencia de los ACV fue de 181,3 casos por cada 100.000habitantes y año. La tasa de incidencia del PACVV fue de 125,7casos por cada 100.000 habitantes y año. El 73,4% de los PACVVfue isquémico y el 26,6%, hemorrágico. Se encontró un elevadoporcentaje de hipertensión arterial, tanto en los pacientes con ACV(84%), como con PACVV (80,7%), y se observó una asociación estadísticamentesignificativa entre la insuficiencia cardíaca congestivay el ACV isquémico

Introduction. Knowledge about the epidemiology of cerebrovascular accidents (CVA), or stroke, in the town of Rivera,Uruguay, would be useful as the basis on which to apply health care strategies both in the prevention of risk factors and inearly diagnosis and treatment. Aims. To determine the incidence of CVA in the town of Rivera and to study the associationbetween certain risk factors and the pathological type of CVA. Patients and methods. The study, which spanned the periodbetween 1st March 2000 and 28th February 2001, was conducted in the town of Rivera, which has a population of 62,859 andis located in the north of the Eastern Republic of Uruguay. The sample consisted of 114 patients with CVA, of whom 79 had noprevious history of CVA –first CVA in lifetime (FCVAL)–. Results and conclusions. The incidence of CVA was 181.3 cases per100,000 inhabitants per year. The incidence of FCVAL was 125.7 cases per 100,000 inhabitants per year. 73.4% of the FCVALwere ischaemic and 26.6% were haemorrhagic. A high percentage of arterial hypertension was found in patients with CVA(84%) and with FCVAL (80.7%), and a statistically significant association was observed between congestive heart failure andischaemic CVA

Estudio piloto de la prevalencia de las principales enfermedades neurológicas en el Uruguay / The prevalence of leading neurologic diseases in Uruguay: a pilot study

Se proyectó un estudio para estimar la prevalencia de las principales enfermedades neurológicas en el Uruguay. El estudio piloto fue llevado a cabo en Migues, población semirural al noreste de Montevideo. Se trata de un estudio epidemiológico transversal en dos fases: en la primera de ellas se realiza un cuestionario puerta a puerta, en la segunda se examina a las personas-posibles portadoras de las enfermedades en estudio. Se puso a prueba el diseño y la metodología y se estudió la sensibilidad y especificidad de los instrumentos utilizados. Se encuestaron un total de 682 hogares que corresponden a los 1975 habitantes de la localidad. Se obtuvieron las siguientes tasas de equivalencia puntuales: epilepsia 9,1 por 1000, convulsiones febriles 7,2 por 1000, accidentes vasculares encefálicos 7,6 por 1000, accidentes isquémicos transitorios 4,6 por 1000, enfermedad de Parkinson 4,0 por 1000, temblor esencial 8,6 por 1000, síndromes demenciales 10,6 por 1000. Se concluye a la factibilidad del estudio, habiendose obtenido cifras de sensibilidad y especificidad variables para cada área, pero todas ellas dentro de los parámetros aceptables. Se discuten los errores cometidos así como se proponen soluciones para corregir los mismos en vistas al estudio definitivo que proyecta realizarse con una población de mayor talla(AU)

Estudio piloto de la prevalencia de las principales enfermedades neurológicas en el Uruguay / The prevalence of leading neurologic diseases in Uruguay: a pilot study

Se proyectó un estudio para estimar la prevalencia de las principales enfermedades neurológicas en el Uruguay. El estudio piloto fue llevado a cabo en Migues, población semirural al noreste de Montevideo. Se trata de un estudio epidemiológico transversal en dos fases: en la primera de ellas se realiza un cuestionario puerta a puerta, en la segunda se examina a las personas-posibles portadoras de las enfermedades en estudio. Se puso a prueba el diseño y la metodología y se estudió la sensibilidad y especificidad de los instrumentos utilizados. Se encuestaron un total de 682 hogares que corresponden a los 1975 habitantes de la localidad. Se obtuvieron las siguientes tasas de equivalencia puntuales: epilepsia 9,1 por 1000, convulsiones febriles 7,2 por 1000, accidentes vasculares encefálicos 7,6 por 1000, accidentes isquémicos transitorios 4,6 por 1000, enfermedad de Parkinson 4,0 por 1000, temblor esencial 8,6 por 1000, síndromes demenciales 10,6 por 1000. Se concluye a la factibilidad del estudio, habiendose obtenido cifras de sensibilidad y especificidad variables para cada área, pero todas ellas dentro de los parámetros aceptables. Se discuten los errores cometidos así como se proponen soluciones para corregir los mismos en vistas al estudio definitivo que proyecta realizarse con una población de mayor talla